Order of Contents...........=
...........................................................................=
......................................................................... <=
/span>1
7: A. Respect, Dignity and Choice ..........................................=
...........................................................................=
............ 3
7.A. 1. a) Self Determination..........................................................................=
.................................................................... 4
7.A. 1: Informed Consent....=
...........................................................................=
.................................................................... 5
7.A. 2: Personal Care.......=
...........................................................................=
........................................................................ 5
7.A. 3: Privacy…………………=
230;…………………………&=
#8230;…………………………=
;................. ............................... 5
7.A.3. i: Telephone usage...=
...........................................................................=
.................................................................... 5
7.A. 4: Personal Possessions……………R=
30;…………………………&#=
8230;…………………..........................................=
.. 6
7.A. 5: Searches…………………&#=
8230;…………………………=
…………………………̷=
0;..........................................=
..... 6
7.A. 6: Pets................=
...........................................................................=
...........................................................................=
..... 7
7.A. 7: Visitors............=
...........................................................................=
...........................................................................=
... 7
7.A. 8: Alcohol and Tobacco Products: People Supported..........................................=
............................................... 7
7.A. 9: Advocacy: Training, support, linkages.................................................................=
............................................. 8
7.A. 10: Cultural Sensitivity..........................................................................=
..................................................................... 8
7.B. Planning..........................................=
...........................................................................=
................................................... 8
7.B. 1: Individualized Planning of People Receiving Services..........................................=
........................................... 8
7.B. 2: Person Centred Planning........................................................................=
............................................................... 8
7.B. 3: PCP Review: Semi-Annual Reports................................................................=
...................................................... 8
7.B. 4: Individual Program Plans.......................................................................=
................................................................ 8
7.B. 5: Individual Care Plans..........................................................................=
.................................................................... 8
7.B. 6: Risk versus Choice..=
...........................................................................=
.................................................................... 9
7.B. 7: Health Care Plans...=
...........................................................................=
...................................................................... 9
7.B. 8: Schedules and Activities.......................................................................=
................................................................ 9
7.B. 9; Children’s Compressive Plan of Care (CPOC)..........................................=
.......................................................... 10
7.B. 10: Goal Tracking......=
...........................................................................=
........................................................................ 11
7.C. Behavior Support: Based on Mandt System .........=
...........................................................................=
..................... 11
7.C. 1: Overview............=
...........................................................................=
...........................................................................=
11
7.C.2: Positive Approaches..=
...........................................................................=
.................................................................. 1=
1
7.C. 3: Proactive Intervention7.C. 4: Motivating People...=
...........................................................................=
.................................................................... 11
7.C. 5: Written Behavioural Plans for Challenging Behaviours..........................................=
......................................... 11
7.C.6: Safety Plans.........=
...........................................................................=
.......................................................................... =
12
7.C. 7: Aggressive and Unusual Behaviour.................................................................=
................................................... 12
7.C. 8: Restraint...........=
...........................................................................=
...........................................................................=
.. 12
7.C. 9: Emergency Restraint.=
...........................................................................=
................................................................... =
13
7.C. 10: Seclusion..........=
...........................................................................=
...........................................................................=
13
7.C. 11: Exclusionary Time out7.C. 12: Prohibited Practices Aversive Strategies Never to be Used<=
span
style=3D'mso-tab-count:2 dotted'>..........................................=
................................ 14
7.D: Physical Interaction .........=
...........................................................................=
............................................................... 14
7.D. 1: Overview............=
...........................................................................=
...........................................................................=
14
7.D. 2: Guidelines for Staff=
...........................................................................=
...................................................................... 15
7.D. 3: Examples of Appropriate Touch..................................................................=
......................................................... 15
7.D. 4: Examples of Inappropriate Touch................................................................=
........................................................ 15
7.E. Sexuality..........................................=
...........................................................................=
................................................... 16
7.E. 1: Overview............=
...........................................................................=
...........................................................................=
. 16
7.E. 2: Respect for Moral Choices......................................................................=
.............................................................. 16
7.E. 3: Education and Training7.E. 4: Support for Special Needs......................................................................=
............................................................... 16
7.E. 5: Privacy and Respect.=
...........................................................................=
................................................................... =
16
7.E. 6: Sexual Safety.......=
...........................................................................=
.......................................................................... =
17
7.E. 7: Development of Friendships.....................................................................=
............................................................ 17
7.E. 8: Informed Consent for Sexual Relationship.................................................................=
......................................... 17
7.F. Nutrition..........................................=
...........................................................................=
................................................... 18
7.F. 1. Nutrition and Food Services Audit Program..........................................=
............................................................. 17
7.G. Health Services for Community Living (HSCL);
Delegation/Transfer of Function=
..........................................=
18
7.G. 1: Overview............= ...........................................................................= ........................................... ............................... 18<= o:p>
7.G. 2: Consent to health care and rehabilitation treatment:..........................................=
............................................... 19
7.G. 3: Levels of Care: ....=
...........................................................................=
......................................................................... <=
/span>19
7.G. 4: Section I Tasks: Standard Practice Tasks.................................................................=
.......................................... 19
7.G. 5: Section II Health Care tasks Which May Be Delegated to a
Support Worker......................=
........................ 19
7.G. 6: Section III Health Care Professional Tasks..........................................=
............................................................... 20
7.G. 7: Acceptance of Delegation/Transfer of Function: ..........................................=
................................................... 20
7.G. 8: HSCL Staff Training for a Delegated Function..........................................=
......................................................... 20
7.G. 9: HSCL Monitoring of a Delegated Function:.................................................................=
...................................... 21
7.G. 10: Staff cross-registered without the necessary Section II
training:...........................=
...................................... 21
7.H: Records and Documentation:
7.H. 1: Overview: ..........=
...........................................................................=
...........................................................................=
21
7.H. 2: People accessing their Records.................................................................=
........................................................... 21
7.H. 3: Ownership of Records= ...........................................................................= ................................................................ 22<= o:p>
7.H. 4: Security, Contents, Transfer & and Storage..........................................=
............................................................ 22
7.H. 5: Progress Notes/ Charts7.H. 6: Staff Communication Book.......................................................................=
............................................................. 23
7.H. 7: Order of Files for People supported.................................................................=
.................................................... 23
7. A: Respect, Dignity and Choice=
:
All
people supported must be treated with respect and dignity and have their
choices respected.
Services offered by K= ardel are voluntary and people consent to be part of the Kardel service system. <= o:p>
Kardel adheres to the=
basic
assumption that people with developmental disabilities are able to direct t=
heir
affairs and make their own decisions.
It is incumbent upon =
staff
members to provide information in plain language and in a manner the person
understands to assist them with decision-making. The people we support must=
be
educated about the potential risks and benefits involved in decisions for
informed decision making. For people to make decisions independently, facts
must be provided, and coercion avoided. Pertinent information must be provi=
ded
in a timely fashion. Risks and benefits must be weighed, with assistance
provided to mitigate risks to ensure the person supported is making an info=
rmed
choice. For decisions about concurrent services, staff members must ensure
informed consent or refusal of expression of choice. For people who are
non-verbal, this may involve accompanying the person to assess their non-ve=
rbal
communication about their receptivity to concurrent services.
In situations where t=
he
person requests, requires or agrees to assistance with decision-making, fam=
ily
or advocates will be invited to participate with the person as a
“proxy”. For example, families/advocates review expenditures ma=
de
on behalf of a person who is not able to manage money to ensure purchases a=
re
in keeping with the person’s best interests. This occurs as part of t=
he
annual Person Centred Planning (PCP) process.
In situations where t=
he
person we support has been judged by the Courts not to be capable, a Commit=
tee
of the Person may be appointed to act on their behalf. In these situations,=
the
Committee has the right to make all decisions pertaining to the person with=
in
the guidelines laid down in legislation. Our role as service providers is to
ensure the Committee is involved in decision-making on the person’s
behalf.
In situations where t=
he child
or youth is under a custody order, the child’s social worker is invol=
ved
in all issues where consent is required. The child, youth cannot be
interviewed, photographed, filmed, videotaped, tape recorded or otherwise
identified by anyone for a public or teaching purpose without the written
permission of the child’s social worker.
In situations where t=
he
person we support has signed a Representation Agreement appointing a person=
(s)
to be involved as their Representative, the Representative ensures the wish=
es
and values of the person are honoured. The Representative may make financia=
l,
legal, health or personal care decisions for the person. Our role as service
providers is to involve the Representative in decision-making.
In situations where t=
he
person we support has a Public Trustee appointed by the courts, our role as
service providers is to involve them in making decisions about his/her pers=
onal
affairs and significant decisions, such as placement, or consent to medical
treatment.
Consent to provide he=
alth
care is sought by the professional providing the health care, including
physicians, dentists, nurses, physiotherapists, psychologists, occupational
therapists, optometrists, chiropractors and others. Our role as service
providers is to provide information that may assist professionals. For exam=
ple,
service providers that are very familiar with the person may be able to cla=
rify
the person’s communication to assist the professional in assessing le=
vel
of understanding of the treatment. Staff members should inform the practiti=
oner
when the courts have appointed a Committee and the name and phone number of
that person for consent; or the name and phone number of the Representative=
if
a Representation Agreement is in place; or the name and phone number of the
social worker when the child/youth is a ward; or the name and phone number =
of
the family when the youth is under the age of 19 and parental consent is
required. Staff members should also provide the information on the appropri=
ate
Temporary Substitute Decision Maker, as indicated on the admissions form, if
required. In emergency situations physicians may act without consent.
Managers/PIC are resp=
onsible
for requesting “permission to treat forms” from the physician p=
rior
to taking them for day surgery etc.
Policy Group: &nbs=
p; Individual
Centered Services
Issued: =
; &n=
bsp; November
2002
Revised: &=
nbsp; December
2007; May 2009
Reference: =
&nb=
sp; Reference:
“Take Charge; It’s your life!” available through the Kard=
el
office or The People’s Law School Telephone 604 331-5400 w=
ww.publiclegaled.bc.ca
=
; &n=
bsp; =
; The
Representation Agreement Act; The Health Care (Consent) and Care Facility
(Admission) Act
=
; &n=
bsp; =
; The
Adult Guardianship Act; The Public Guardian and Trustee Act
=
; &n=
bsp; =
; Let
Me Decide: The Health and Person Care Directive That Speaks for you when you
can’t; 3rd edition; Dr. D. William Molloy 2005; CARF handout: Informed
Consent; 2002
7.A. 1. a) Self-Determination
People have the right=
to
self-determination to make decisions pertaining to their lives. We respect
their right to decide on the participants for their planning meetings and h=
ave
input into their service teams and staff members working directly with them=
. (Cross
Reference 3.A. 2 c)
7.A. 2: Personal Care
Intervention should b=
e as
non-intrusive as possible, and the independence of the person should be
encouraged. The hierarchy of intrusiveness would be reminders, prompting,
partial assistance, hand over hand, and total assistance.
Dignity and respect a=
re
integral to the provision of personal care. A written personal care plan sh=
ould
outline the methods, positioning and order for provision of personal care f=
or
the person supported to ensure proper care. The person supported should be
encouraged to participate to the optimum degree possible. The process of
providing personal care should be used to teach personal boundaries and pro=
vide
knowledge of the body. If the person is able to give input, communication
should occur pertaining to how personal care tasks will be performed.
Staff members assisti=
ng with
personal care should do so in a private place, outside the view of other st=
aff
members and/or other people living in the home. Ensure the person is not
visible to people walking by the home or doorway. When away from home,
determine in advance where suitable private washrooms exist so that personal
care may be provided outside the view of other people. Cultural sensitivity
issues re: personal care is addressed in the individual care plans.
Employees wear dispos=
able
gloves to prevent contamination of hands from blood, feces, or body fluids =
or
to protect hands from strong cleaning fluids. Use a face cloth to avoid skin-to-=
skin
contact when washing. Explain to the person what you are doing while you are
doing it. Maintain eye contact, or avert your eyes from the private parts of
the body. Some people supported may need careful examination for signs of s=
kin
breakdown and this will be written in the health care plan. Use the correct
words for parts of the body if making reference to parts of the body. Ensure
your own actions convey confidence to avoid embarrassment. If the person is
able to grant permission, request their permission before proceeding. Keep
private parts of the body covered with a sheet as much as possible.
Volunteers and peers =
should
not be involved in the provision of personal care. The number of staff memb=
ers
involved in the person's personal care should be as limited as feasible. Pe=
ople
served may request a staff person of their gender provide personal care. Su=
ch
requests for gender specific personal care giving must be approved by Hospi=
tal
Employees Union.
=
Policy Group: &nb=
sp; =
Individual
Centered Services
=
Issued: =
&nb=
sp; July
1998,
=
Revised: &=
nbsp; &nbs=
p; &=
nbsp; May
2001; December 2007; May 2009
=
Reference:
&=
nbsp; &nbs=
p; Proto=
col
for Personal Care: Community Options for Children and Families
Study Guide: Infection Control for Community Care Workers: Developed=
by
Alpha =
Home Care Services Ltd. And
7.A. 3: Privacy
The people we support=
are
entitled to privacy unless there are safety considerations that override the
need for privacy. The team, in consultation with the facilitator/analyst/fa=
mily
as appropriate, would weigh the conflicting values to ensure ethical
decision-making.
Each person has a pri=
vate
bedroom and storage space as stipulated in the Community Care and Assisted
Living Regulations. Private discussions with a person should occur in a pri=
vate
location.
Staff are required to=
knock
and wait for permission prior to entering a bedroom. If the person is not a=
ble
to give permission, staff knock first and enter after a reasonable interval=
.
People are entitled to
privacy when they entertain family, friends or visitors as long as there ar=
e no
safety considerations. Staff will make an effort to provide privacy within
common space if possible.
7.A.3.i: Telephone Usage
Access to a telephone=
must be
available to the people supported at all times and at their request. Assist=
ance
should be provided as required to access a phone number, dial the phone num=
ber,
hold the phone as required, and hang up as required. Where the person is ab=
le
to hold the phone independently or with adaptations, the person should have
total privacy for their phone conversation. Directions for staff members for
facilitating the use of a phone must be in the persons individual care plan=
.
In situations where t=
he
person spends extensive periods of time on the telephone, a private line ma=
y be
requested.
7.A. 4: Personal Possessions
People express their
individuality by their personal possessions and every effort will be made to
accommodate them. People are encouraged to care for their personal possessi=
ons,
to place their name on personal possessions and if they are not able to look
after them, staff members assume responsibility for assisting them or caring
for them.
An asset registry is
completed on moving into the home and updated as new items are added or del=
eted
for all personal possessions
People are not allowe=
d to
keep guns, weapons, explosives, drugs or prohibited items. The company will=
not
assume responsibility for loss or damage to items of high value i.e. jewelr=
y,
works of art, etc. and the person should be encouraged to make arrangements=
for
personal insurance.
Staff may be required=
to
complete a search of a private room within the home if there is reasonable
cause to believe there is a weapon; drugs, stolen goods, or possessions that
may cause harm or be illegal. The search must be approved by the Manager an=
d an
incident report must be completed; or it must be part of an approved safety
plan. Any search procedure must be respectful and the least intrusive appro=
ach should
be used. Under no circumstances are body or strip searches allowed.
Pets at the homes/pro=
grams
must be there for the sole benefit of the individuals living in the home or=
at
the program and with the supported person’s permission. People with
allergies, sensitivities or fear of animals should not be exposed to animal=
s in
their home or workplace and aversion or sensitivity to pets should be discu=
ssed
on intake if pets already reside in the home. Pets must not be at
homes/programs where people may injure an animal.
Staff members should
recognize the need to support people in the life style they select. In homes
where the people supported have pets, staff members should consider this pr=
ior
to accepting work in the home and should avoid these homes if they have
allergies, sensitivities or fear of animals.
All costs associated =
with pet
care i.e. food; vet care etc. must be born by the individual that owns the
animal. If the animal belongs to “the house” the costs must be
shared among all people supported from their comforts money. It must be
understood that if another person supported in the home, for whatever reaso=
n,
is unable to continue to benefit from the animal in the home, a new home wi=
ll
have to be found for the animal.
Pets that disturb the=
peace
and quiet of the home and/or the neighborhood should not be at the homes and
programs. The pet owner must dispose of any droppings. Our goal is to maint=
ain
an excellent reputation as a neighbor.
The care and control =
of any
animal must not interfere adversely with the supervision and support requir=
ed
by the people in the home/program. Workload should not be increased for oth=
er
team members because of the care of an employee’s animal.
Pets are not allowed =
in
Kardel vehicles.
People may benefit fr=
om
having animals visit the home/program. Managers should discuss this issue w=
ith
people supported to get their input prior to animals coming to the
home/program. Discussion should occur among the team to ensure agreement th=
at
an animal living on site or visiting would be beneficial to the people
supported.
Pets may be brought t=
o the
worksite only with the direct approval of the manager after input from the
regular team. Consideration should be given to the following:
q =
Safety concerns: (i.e. mobility issues of the pe=
ople
in the home/ program etc.)
q =
Health concerns: (i.e. fleas, allergies, sheddin=
g of
hair, cleanliness, waste disposal etc.)
q =
Work load concerns: (i.e. time for feeding anima=
l,
entertaining etc.)
q =
Temperament of the animal (i.e. size, excitabili=
ty of
the animals etc.)
q =
Regular staff members’ allergies, sensitiv=
ities
and fear of the animal
Any damage caused by =
a pet on
site will be the responsibility of the owner.
We encourage the invo=
lvement
of friends and acquaintances in the lives of the people we support and we w=
ork
towards expanding their social networks. The home staff provides a welcoming
atmosphere and makes refreshments available to guests. As appropriate, priv=
acy
is provided. Visitors are invited to participate in activities occurring wi=
thin
the home, system i.e. music nights, dances etc. Visitors will be directed to
appropriate parking.
Visitors will be expe=
cted to
respect the needs of all people in the home and staff, and abide by the
requests of staff that are familiar with the needs of all parties. If visit=
ors
pose a risk, cause disruption, or refuse to abide by requests, the manager =
may
deny visiting rights. An incident report should be forwarded to central off=
ice.
If people are requesting to visit in the home, the manager will screen to
ensure the person in the home wants the visitor, and that there is no
indication that the visitor would cause risk or harm. See form “Relea=
se
of a Person Supported” in the forms book which lists the names of peo=
ple
who may pose a health or safety risk.
7.A. 8: Alcohol and
Tobacco Products: People Supported
Kardel respects the r=
ights of
people to make independent decisions pertaining to the use of alcohol and
tobacco products. People who are able to give informed consent and who requ=
est
alcohol or tobacco products may be assisted with the purchase of alcohol or
tobacco products as long as they are legally entitled to do so. Staff membe=
rs
may accompany people supported to a place that serves alcohol, though staff
members would be considered on duty and must not consume alcohol. Any alcoh=
ol
or tobacco products in the home should be labeled with the name of the owner
and kept in a locked cupboard.
When people are not a=
ble to
provide informed consent, the Committee or Representative will be involved =
in
any decisions pertaining to alcohol consumption. For people with medical or
addiction problems, he/she would be encouraged and assisted to discuss the
issue of alcohol consumption or the use of tobacco products with their
physician. Individual Care Pl=
ans
(ICP) would address the issue of alcohol consumption or use of tobacco prod=
ucts
to provide staff members with clear, consistent guidance.
The homes and programs
operated by Kardel including all vehicles are classified as non-smoking are=
as.
People supported and staff members who smoke or use tobacco products must d=
o so
outside the home within a 3 metre buffer zone of workplace doorways and by
windows that can open and air intakes. No smoking is allowed within a fully=
or
substantially enclosed space i.e. if it has a roof or other type of cover a=
nd
more than 590% of the “nominal wall space” preventing the air f=
rom
flowing easily through it.
Appropriate containers, such as large coffee tins with sand, are to =
be
used for the disposal of ashes and butts. The people that smoke are respons=
ible
for clean up. Caution is to be used to protect others from second hand smok=
e. A
person served is not to be left unattended while a staff member is smoking.=
Policy Group: =
; Individual
Centred Services
Issued: =
; &n=
bsp; 1998
Revised: &=
nbsp; October
2000; September 2002; January 2004; October 2005; November 2007
Reviewed: &n=
bsp; May
2009
References:
7. A. 9: Advocacy
All people supported =
receive
notification of meetings for “Self Advocates for a Brighter Future=
221;.
This self advocate group is co-sponsored between Kardel and Becon Support
Services. Training is provided on self advocacy as well as encouragement for
the development of networks and friendships. Information is shared on other
events and happenings in the community. Information is circulated to people
supported and families regarding systems advocacy activities. Information h=
as
been forwarded on self advocates websites e.g. www.startwi=
thHi.ca Families are encouraged to get their name on the
Kardel email list (forward to karen@k=
ardel87.com) to receive these notifications
expeditiously.
Policy Group: =
; Individual
Centred Services
Issued: =
; &n=
bsp; July
2009
Cross Referen= ces: Section 3. D. 1<= o:p>
7.A. 10: Cultural Sensitivity
Cultural heritage is =
the
shared customs, beliefs, behaviours and traditions of a particular group. We
respect the right for people to receive guidance and encouragement to maint=
ain
their cultural heritage for a positive sense of belonging and personal
identity. Staff members must demonstrate respect from the person’s un=
ique
culture and heritage. Support is demonstrated by providing access to resour=
ces
and information where desired as well as respecting the persons traditions,
language, religion, food and customs. Kardel hires people that are
representative of a diverse group of cultures and heritages.
Kardel orients staff =
members
to the requirement for respecting the culture of the people supported. Kard=
el
ensures a representative from each site receives the Safe Harbour Program
Training through the intercultural association and takes the information ba=
ck
to their team meetings. Kardel also displays
Policy Group: =
; Individual
Centred Services
Issued: =
; &n=
bsp; July
2009
Cross Referen= ces: Section 3. D. 1<= o:p>
7.B: Planning
7.B. 1: Individualized Planning for People Recei=
ving
Services
Consistent
with Kardel’s philosophy, our services work towards serving people in=
a
manner that respects their individual choices, personalities, histories,
culture and beliefs. Prior to entering our services, we gather as much
information as possible from the person themselves, their families and supp=
ort
networks to assist in providing optimal service. Permission is sought from =
the
person and appropriate consents signed in order to access prior assessments=
and
reports that will assist our services in understanding the individual’=
;s
needs. We provide a copy of our handbook and ensure the materials are deliv=
ered
in a manner that the consumer and their families understand to ensure our
services will meet their needs. We work cooperatively with other services
involved in the lives of the people we support to ensure efficient and
effective services.
7.B. 2 : Person Centred Planning (PCP)
Person centred plans =
are
completed by key workers within the first three months of the person enteri=
ng a
home/program and annually thereafter. People in attendance sign the PCP form
and receive a copy of the completed document so they may approve it or requ=
est
changes. The people supported are assisted in providing as much input as
possible into the process. Alternative communication strategies are used as
required. Families, in conjunction with the people supported, are encourage=
d to
give input into service design, activities, and the likes and dislikes of t=
heir
family member and this input is used as a basis for planning. Copies of the PCP are kept in the personR=
17;s
binder in the home/program. Satisfaction with their home/program is reviewed
and alternatives discussed. Detailed PCP planning guidelines and forms are
available in the forms book.
7.B. 3: PCP Review: Semi-Annual Reports
Key workers are respo=
nsible
for completion of a semi-annual review summarizing the progress towards the=
PCP
goals with input from the person and their support network. Copies of
Semi-Annual Report are forwarded to Central office with a copy kept in the
person’s binder. These will also be forwarded to the person’s
family or support network to assist them in seeing the progress towards the=
PCP
goals as well as the CLBC analyst as the monitor and funder of our services=
.
7.B. 4: Individual Program Plans (IPP)
Programs operated by =
Kardel
will have input into the PCP through the home where the person lives at the
invitation of the person and their home. A copy of the PCP is requested for=
the
person’s day program records.
A more specific plan =
is
developed within day programs to delineate the outcomes that are being work=
ed
towards with the person supported and performance indicators. The IPP should
delineate specific instructions to staff members regarding the best methods=
to
assist the individual in meeting goals. See forms book for details on IPP
planning and form.
7.B. 5: Individual Care Plans (ICP)
Individual Care Plans=
are
developed, ideally, before the person moves into a home/program, for consis=
tent
understanding of the needs, personality, culture, likes and dislikes of the
person served. The plan should outline clearly the techniques to be used, a=
nd
supplies and equipment required.
Based on need, topics covered include: communication, mobility,
transfers, bladder, bowels, sleeping patterns, daily routines,
showering/bathing, washing hands and face, tooth brushing, mouth rinse,
shampooing, combing hair, shaving, menstrual care, dressing, fingernails,
toenails, meal preparation, eating, use of telephone, transportation,
allergies, skin care, circulation, independence (places to encourage choice=
s),
ways to respect rights & culture, leisure and recreation, nutrition, sa=
fety
and security, seizures, exercises, vision, support systems to encourage, to=
uch,
use of hot and cold compresses and social activities.
7.B. 6: Risk versus Choice
As we are committed to
ensuring the health and safety of the people we support, we are also commit=
ted
to self-determination and we recognize the dignity inherent for all of us in
taking risks. Hence, when the person we support wishes to engage in potenti=
ally
risky behaviour, the support network and team need to make assessments in
relationship to these conflicting values to arrive at an appropriate decisi=
on
pertaining to the support that will be extended in attempting to honour the
person’s choice. For example, there may be the conflicting values of
respecting the right to privacy with locking bedroom and bathroom doors, to=
the
need to provide safety and security.
The following is sugg=
ested as
a process for the person, the support network and the team in situations wh=
ere
there are conflicting values and opinions:
q =
Be specific about the activity and the inherent =
risks
q =
Ensure the person has “expert” infor=
mation
on the risks and understands same. When there may be physical implications,=
the
person should receive information from their physician.
q =
Clarify with the person the anticipated
rewards/benefits for them from the activity
q =
Clarify the ramifications of the person not being
supported to participate in the activity
q =
Develop a plan to minimize risks
q =
Have the person, his/her support network and team
agree on a plan that specifically defines the activity, the risks, and the
level of support to be provided.
q =
The plan should be kept with the Individual Care=
Plans
and revisited annually in conjunction with ICP review.
7.B. 7: Health Care Plans (HCP)
When the person has no
significant medical issues, basic health care issues are delineated in the
individual care plan and generic services are used as required.
When the person has
significant medical issues, Health Services for Community Living works with=
the
person and their support system to develop a Health Care Plan that identifi=
es
and delineates action for health and safety issues. This plan is kept in the
person’s binder and reviewed regularly by the Manager/staff members a=
nd
revised as required by the professional.
7.B. 8: Schedules =
and
Activities
The services offered =
by
Kardel are individualized to the likes, wishes and needs of the person serv=
ed.
We use a team approach with monitoring by the manager to ensure the biases,
preferences, energy level, and personal wishes of staff members are not imp=
osed
inadvertently on the person supported.
People are involved in
establishing their regular routines and preferences are documented in
Individual Care Plans. People set goals in annual Personal Centred Plans or
Individual Program Plans (programs) and these are built into their schedule=
s.
We ensure we are helping the person meet their goals by tracking through the
goal tracking sheets.
For children and yout=
h, the
home would work with the school in encouraging and supporting their educati=
onal
goals and participating in their Individual Education Plan.
Managers develop the
schedules for the person served with input from the individual and their key
worker, taking into consideration the resources and the needs and wishes of=
all
people being served. Schedules are shared with the team for input and
satisfactory follow up with scheduled activities forming part of the job
expectation for employees. Variations in schedules are to be pre-approved; =
if
this is not possible, reporting on the reasons for schedule changes should =
be
documented and reviewed by the manager. The inability to successfully compl=
ete
scheduled activities with the people supported forms part of the performance
evaluation of staff members.
To record all outings=
and
activities, use the desk calendar in each home
Note
the name of the activity
Be
specific ie. Spitfire restaurant at airport so it will be identifiab=
le
for future reference
Note
the name of the person(s) that participated
If a
planned outing is noted on calendar and does not occur, put a line through =
it.
Calendars will be kep=
t for
three years for reference.
When there may be per=
ceived
benefits for staff members in an activity, a careful review of the activity
must occur with key worker and manager to ensure it is in keeping with the
likes, wishes and needs of the person served. All potential conflicts of
interest or breaches of ethics require careful review and approval prior to=
the
activity.
The following are exa=
mples of
staff members extending their personal lives into the lives of people suppo=
rted
with positive benefit for the person and where we trust the intent is in the
person’s best interest:
q =
The person may love animals, and benefit from vi=
siting
the farm of a staff member.
q =
The person may love hockey games and a staff
member’s child may be playing hockey nearby.
q =
The person may like to bake in a peaceful settin=
g, and
a staff member may be willing to lend the use of their kitchen.
q =
A person with no religious affiliation in their
history may have expressed an interest in going to Church, and the staff me=
mber
knows that they could facilitate supportive relationships at the Church they
attend.
Given these same situ=
ations,
the same activities may be highly inappropriate and not meeting the needs of
the people supported:
q =
A staff member may be going to the farm and taki=
ng a
person because they need to do a chore.
q =
A staff member may wish to see their child play =
hockey
and is misconstruing the person’s pleasure in the activity.
q =
A staff member may wish to do personal activitie=
s at
home and is using the person as an excuse to do this.
q =
A staff member may wish to impose his or her own
religious beliefs on the person.
These examples all hi=
ghlight
the need for due diligence in the creation of approved schedules, careful
monitoring, recording of follow up of activities, and team discussion.
Spontaneous schedule changes should be reported and explained to ensure they
are focused on the best interests of the person supported.
Within all schedules =
and
activities, safety is paramount. For people living in licensed facilities,
supervision must be provided at all times. People are not to be left
unattended. Activities are tracked on an activity calendar. Calendars are k=
ept
for three years to allow for review of activities.
7.B. 9: Children’s Comprehensive Plan of C=
are
(CPOC)
For children and yout=
h under
the age of 19, the planning process is outlined by Ministry for Children and
Family Development and the social worker coordinates the Children’s
Comprehensive Plan of Care. The manager of the home is responsible for ensu=
ring
the participation of the child/youth, parents and others of significance. T=
he
CPOC identifies court orders where we are required to cooperate and comply.
CPOC outlines the types of services and interventions required, including
specific detail about monitoring of children’s or youth’s safety
and well being. Within the CPOC individual goals strengths, aptitudes and
wishes are recorded, as well as the family strengths. The estimated length =
of
participation in the program and anticipated follow up services are address=
ed.
The responsibilities of the child/youth and parents are recorded in the CPO=
C.
CPOC are completed annually. Measureable goals are established and tracked
monthly.
7.B. 10: Goal Tracking
Plans established at =
the PCP
are recorded on a goal tracking sheet and progress towards goals are record=
ed
throughout the year. Keeping goals measurable helps to ensure we are delive=
ring
the services people wish to receive. Progress towards goals are reported ou=
t on
in semi-annual reports, which are sent to families and the social worker, w=
ith
the person’s consent.
7.C. 1: Overview:
Based on functional
assessments, our goal is to create “environments for competence”
that will facilitate providing the least amount of structure necessary for
individuals to live, learn, work and play independently and develop support
plans that are designed to help individuals use their own strengths to meet
their own needs.
7.C. 2: Positive Approaches
Positive behavior sup=
port
approaches are developed and used to address challenging behaviours. These =
may
include modifying the environment to help the person function more successf=
ully;
reinforcing positive behaviour; teaching/shaping appropriate behaviours and=
/or
communication; providing appropriate programming for optimal functioning et=
c. A
team approach is used to determine the communicative intent of the
person’s behaviour and devise care plans/protocols for helping the pe=
rson
supported. Professional consultation is available.
7.C. 3: Proactive Intervention
A preventative orientation to problems is paramount, in which
foresight, tolerance, adequate planning and realistic expectations keep fea=
r,
frustration, anger, misunderstandings or longstanding habits from creating
disruptive situations. There are no “make or break” situations =
in
pursuit of community inclusion and personal growth. A constructive process =
avoids
power tactics and confrontation and is paced and ongoing. There will always=
be
further opportunities for learning to occur. Positive training approaches, a
preventative orientation, an environment conducive to growth, and the absen=
ce
of restrictive, punitive measures will assist in minimizing the number of
crises.
7.C. 4: Motivating People
Where a concentrated =
effort
at behavioural change is necessary, it is important to determine, in additi=
on
to what needs to be learned, how best to motivate the individual in support=
of
such a change. Staff members must challenge themselves to identify and prov=
ide
the motivators (incentives) that make the challenge of replacing potentially
longstanding and automatic behavioural patterns worthwhile.
7.C. 5: Written Behaviour Support Plans for
Challenging Behaviours
The approaches used a=
re
individualized to the person’s needs. Written behavioural plans as we=
ll
as care plans/protocols are completed to ensure consistency among staff. All
employees are required to follow written protocols. During orientation,
employees are oriented to the protocols of each person supported and sign o=
ff
on the orientation sheet. The
individualized protocols list expectations regarding response by personnel =
to
emergencies involving assault or aggression if applicable.
A behaviour support p=
lan
document is developed by a behavioural consultant in conjunction with the
individual, their family and service provider and it outlines specific
behaviour support interventions or treatment strategies. It includes implem=
entation
and review requirements. Input will be sought from parents or substitute
decision makers (as noted on their Client Profile, Admission and Transfer F=
orm)
the individual’s Committee or Representative, and staff members who w=
ork
with the individual as appropriate.
7.C. 6: Safety Plans
A safety plan is an
individualized, written document designed to address situations where dange=
rous
behaviour has the potential to harm the individual or those around them. The
Safety Plan outlines the strategies and behaviour support procedures caregi=
ver
is to use to de-escalate the behaviours and reduce risk. They can only be
developed in conjunction with an overarching Behaviour Support Plan. A
behavioural consultant must wirte the plan and it must be signed off by the
physician. (Cross reference 7.C. 8)
Policy Group: &nbs=
p; Individual
Centred Services
Issued: &nbs=
p; &=
nbsp; June
2009
Reference: &=
nbsp; Behaviour
Support and Safety Planning: A Guide for Service Providers CLBC
7.C. 7: Aggressive/unusual behaviour
As mandated by the Wo=
rker’s
Compensation Act, any person supported who has had aggressive behaviour
requires a written behavioural plan and safety plan to ensure the risk to staff member=
s is
reduced.
Managers must ensure =
that all
staff members receive training in the use of any specified behavioural appr=
oach
and guidelines for application prior to working with the person. The plan
should be reviewed in conjunction with the annual personal centred planning=
and
semi-annual reporting, or on a schedule prescribed by an outside consultant=
to
evaluate the outcomes in reducing the problem behaviour.
Any aggressive or unu=
sual
behaviour by a person towards others, which has not been appropriately asse=
ssed
in the individual’s care plan is a reportable incident under the
Community Care Facilities Branch: Licensed Facilities. For a “reporta=
ble
incident”, the staff member’s supervisor/manager shall review t=
he
information on the incident report for Community Care Licensed Facilities, =
sign
it, remove and retain the top (white) copy and immediately forward the
Licensing Officer’s copy to the local Health Authority, and the Fundi=
ng
Agency: CLBC. A photocopy of the Facility Follow-up (back of page 1, white
copy) should also be forwarded to the local Health Authority.
7.C. 8: Restraint
Restraint is defined =
as the
application of chemical, electronic, mechanical, physical or other means in
order to limit or restrict the freedom of movement of a person supported. I=
t is
a restriction on a persons rights.
Restraint includes bu=
t is not
limited to:
=
holding or
restraining a person, physically moving a person from one location to anoth=
er
against their will, wheelchair seat/lap belts, splints, covering on the han=
ds,
bed rails, positioning individuals supported in order to restrict/limit
movement etc.
Restraint is not to b=
e used
for the purpose of changing behavior, punishment or for the convenience of
staff members. Restraint is o=
nly to
be used as a safety response. The
duration of the restraint should be a brief as possible. Restraint will only t=
o be
considered if: =
&nb=
sp;
There is a real threat of harm to the person supported or others.
q =
The risk of harm is imminent to the person suppo=
rted
or other people
q =
All alternatives for safety have been exhausted =
and
discussed among the support team;
q =
The restraint is as minimal as possible and safe=
guards
are in place, if applicable, for the use of the restraint;
q =
The person has approved the restraint or, if the
person is not capable of giving consent, the person’s substitute deci=
sion
maker gives consent;
q =
The person’s medical practitioner approves=
the
restraint method for safety;
q =
The use of the restraint is documented in the
person’s Individual Care Plan on “Consent protocol for
restraint” form;
q =
Th=
e staff
member administering the restraint has received training in the use and
monitoring of the restraint;
q =
There are written policies and procedures accept=
able
to the medical health officer to all aspects of the use of the restraint;
q =
The conditions are serious enough to justify the
methods used.
Restraint protocol is
developed as needed. The manager, the individual’s Physician, OT/PT, =
a Behavioural
Consultant, or Developmental Disabilities Mental Health Services may write =
the
protocol. Consideration is given to an assessment of the person’s
physical and emotional well-being as part of the protocol. The staff team m=
ust
review and familiarize themselves with the protocol in order to ensure
consistency. Reviews should be conducted through regular team meetings. Res=
traint
protocols are signed off by the person supported if possible; family and
physician.
A current “Cons=
ent and
Protocol for Restraint” form must be filled out - located on page 7 of
the Individual Care Plan.
Documentation includes: specific protocol including clear directions=
and
time limits with ensuring the reinstatement of rights as soon as possible.<=
span
style=3D'mso-spacerun:yes'> This form is updated as per the st=
ated
review date. Reviews of the
Individual Care Plan including the restraint protocol occur at least annual=
ly.
The review should include the frequency of restraint use, reasons for use,
alternatives tried, outcome, and person’s reaction to intervention.
7.C. 9: Emergency restraint
The use of an emergen=
cy
restraint to preserve life or prevent serious harm to the person or others
should be as minimal as practicable. Emergency restraint is a Reportable
Incident to Licensing. All homes and programs should evaluate an incident t=
hat
has resulted in an emergency restraint as soon as possible to prevent future
incidents. If the incident is likely to reoccur, a plan should be set in pl=
ace
to address the problem behaviour. Debriefing should occur with the person i=
nvolved;
other people in the home if involved, and when appropriate, the family. In =
the
case of youth, the social worker may also be involved in debriefing. The ma=
nager
provides staff with ready access to personal debriefing, supervision, risk
assessment and reviews, on-going training and direction regarding the future
use of physical restraint when protecting a person supported or others from
physical harm. If the restraint is used as a result of an emergency incident
and continues to be necessary, the review must occur every 30 days.
7.C. 10: Seclusion
Seclusion, where a pe=
rson is
left alone, is not used within any home or program operated by Kardel.
7.C. 11: Exclusionary Time Out
The removal of an ind=
ividual
from a situation and environment for a limited period of time so as to prev=
ent
harm to him/her or to others. Exclusionary Time-Out must be part of an appr=
oved
Behaviour Support-Safety Plan, Each incident must be reported and documente=
d on
an individual’s file. This does not include positive re-direction to a
safe, quiet place.
Policy Group: =
; Individual
Centered Services
Issued: =
; &n=
bsp; July
31, 2009
References:
=
; &n=
bsp; =
;
7.C. 12: Prohibited Practices
Any actions that are =
reliant
on fear, pain, or threats, or that constitute an infringement on the
fundamental human entitlements or rights of a person served.
The following procedu= res are strictly prohibited and could result in discipline up to and including termination:<= o:p>
Policy Group: =
; Individual
Centered Services
Issued: =
; &n=
bsp; 1992
Revised: October =
2000;
September 2002; January 2004; October 2005; November 2007; May 2009; July 2=
009
References:
=
; &n=
bsp; =
; CARF
Employment and Community Services Standards Manual
=
; &n=
bsp; =
; Mandt
Trainer’s Manual
7.D. Physical
Interaction
7.D. 1: Over=
view
Staff members’
interactions with the people supported which convey fond feelings, goodwill,
empathy and caring are highly desirable. Touch, in all forms, is communicat=
ion.
People served by Kardel are entitled to give and receive physical contact
necessary for human growth and development in a manner that authentically
respects the relationship between a staff person and a person served. The f=
orm
of expression must be based upon the quality and length of the relationship;
the history, personality and cultural perspectives of the individuals invol=
ved;
and the personal meaning and interpretation of touch and personal space.
Staff members must at all times exercise=
good
judgment, ensuring all physical interactions will not be construed as sexua=
l or
inappropriate. Staff members must role model socially appropriate touch and
demonstrate safe and appropriate boundaries in their daily interactions. St=
aff
must be aware of support needs outlined in Individual Care Plans and Behavior Support Plans that relate =
to
appropriate touch with each individual
7.D. 2: Guidelines for Staff
Touch is communicatio=
n. Touch
is highly subjective and each individual may respond differently.
Interactions should be authentic, n=
atural
and spontaneous for staff members and the people they support. Guidelines f=
or
touch must be referenced and clearly defined in a behavioural support plan =
for
individuals who may be sensitive to touch/have difficulty with touch.
7.D. 3: Examples of Appropriate Touch
7.D. 4: Examples of Inappropriate Touch
Policy: &nbs=
p; &=
nbsp; Individual
Centered Services
Issued: =
; &n=
bsp; June
1992
Revised: &nbs=
p; &=
nbsp; October
2000; December 2007; May 2009
Reference: &n=
bsp;
=
&nb=
sp; =
The
Mandt System: Trainer’s Manual
&=
nbsp; &nbs=
p;
7.E.: Sexuality=
:
7.E. 1: Overview:
As service providers =
we have
a responsibility to respect persons’ choices regarding their sexualit=
y.
We also have a responsibility to ensure the person’s health, safety, =
and
access to required information; as well as appropriate alternative
communication systems to help them with responsible decision-making. We hav=
e a
responsibility to arrange for specialized assistance as required.
An individual’s
expression of his/her sexuality may encompass relationships with others and=
/
or autoerotic sexuality. As a service provider, we will respect the
person’s right to choose his or her own methods of sexual expression
providing that we are assured that:
q =
Any other person involved is an adult, and that =
both
parties give their informed consent;
q =
The appropriate time and place is chosen;
q =
There is no infringement on the rights of other
people;
q =
The behaviour is not illegal;
q =
Physical safety of the parties involved is assur=
ed.
7.E. 2: Respect for Moral Choices
Kardel acknowledges a=
nd
respects variations of sexual choice and expression as exists in a pluralis=
tic
society.
Employees are expecte=
d to
support sexuality choices as well as exercise good judgment to ensure health
and safety. Staff members will avoid imposing their own moral choices and
respect the moral choices of the individuals they support..
7.E. 3: Education and Training
Staff members will re=
spond to
questions from people supported regarding sexuality in an accurate and
non-judgmental manner in an appropriate place. They will inform the manager=
if
questions are being asked so the team will ensure consistency of information
and so staff members are not handling situations in isolation. If staff mem=
bers
are uncomfortable with the subject matter, the questions are to be forwarde=
d to
the manager for follow up.
If a need exists for further sex ed=
ucation,
the manager will attempt to arrange for appropriate instruction.
7.E. 4: Support for Special Needs
When sexuality issues=
arise
for the people supported, very clear, specific sexuality protocols will be =
set
in place to assist staff members in understanding their roles and
responsibilities. The home manager will seek additional consultation as
required.
Medical input may be sought through=
the
person’s doctor. A referral could be made to the G. F. Strong Sexual
Health Unit in
Alternative communica=
tion
input will be sought when the person supported is without a means of commun=
ication
pertaining to sexual issues.
7.E. 5: Privacy and Respect
The people in the hom=
es will
have private bedroom space. Staff members will not enter bedrooms without
knocking; staff members should try to attain the permission of the person,
unless there are emergency concerns re: health and safety, or unless the pe=
rson
is not able to give consent. Erotic material, if chosen by the person
supported, should be kept in the person's private space outside of public v=
iew.
When documenting sexu=
ality
issues, staff members should ensure that the language used to describe the
issues is positive and respectful of the individual. Approaches dealing with
issues of sexuality will be documented when necessary for consistency, and
supported person’s privacy will be respected by ensuring only people
required to know have access to the information. Sexual history that is not
relevant to the current support needs should not be included in the
person’s records and will be treated as confidential by the house man=
ager.
7.E. 6: Sexual Safety
Under no circumstance= s will staff members or volunteers in the home engage in sexual talk, or touch wit= h a person supported or share erotic materials. Staff members will protect the people they support from sexual exploitation by other people in the home/program, staff members, or people outside the Kardel service system. <= o:p>
7.E. 7: Development of Friendships
Staff members will fa=
cilitate
appropriate social interactions and ensure opportunities exist to form and
sustain friendships.
7.E. 8: Informed Consent for Sexual Relationship=
Informed consent is a=
chieved
if:
The person is 19 or o=
lder;
Sex education appropr=
iate to
the person’s level of understanding has been provided;
The person has demons=
trated
an understanding of, and responsibility for, their sexual behaviour through
discussions with appropriate staff members and /or a professional counselor
(i.e. clergy, psychologist, therapist, social worker);
Birth control and sex=
ual
safety issues have been discussed and understood;
Safeguards are built =
in to
assist the person if assistance is required.
Policy Group: =
; &n=
bsp; Individual
Centered Services
Issued: =
; &n=
bsp; =
; June
1998
Revised: &nbs=
p; &=
nbsp; &nbs=
p; September
2000; June 2004
Reviewed: &nb=
sp; &=
nbsp; December
2007; May 2009
References: =
&nb=
sp; =
“Human Sexuality Handbook: Guiding People toward Positive Expressions=
of
Sexuality” The Association for Community Living.; Sexuality Policies =
and
Procedures Manual;”
=
&nb=
sp; =
=
The
ARC of
7.F.: Nutrition
Kardel complies with =
the
requirements of the Community Care and Assisted Living Act and has inspecti=
ons
by a licensing dietician. Meals and More is available as a reference guide =
in
each home/program. Registration costs are covered for staff members to comp=
lete
Food Safe training.
Consistent with
Kardel’s philosophy of ensuring basic rights are met, each person
supported has the right to three meals and two nourishing snacks per day. F=
ood
preferences of the people supported are respected and personal choices and
cultural food expectations are taken into consideration. Our goal is to ser=
ve
meals in a pleasant, relaxed manner. Appropriate feeding aids are used and
individualized assistance will be provided as required. Adequate supervisio=
n is
available for meal and snack times to ensure the safety and monitoring of a=
ll
people supported. All staff members are oriented to the individual care pla=
ns,
health care plans and nutrition care plans of the people supported.
The individual care p=
lans
indicate meal preparation involvement, eating issues including staff
assistance, utensils, seating, apron etc.; nutrition issues and diet concer=
ns;
issues pertaining to fluids, and mealtime instructions. Monthly weight reco=
rds
are completed for all people supported. Nutrition Care Plans are completed
within two weeks of the person moving into a home. When nutritional concerns
are assessed, a referral is made to HSCL professionals and a health care pl=
an
is provided. The care plan delineates the method for regular follow up of t=
he
person’s nutritional needs.
Policy: =
; &n=
bsp; Individual
Centered Services
Issued: =
; &n=
bsp; October
2001
Revised: =
June
2007
Reviewed: &n=
bsp; December
2007; May 2009
References: =
Meals
and More: Quality Improvement and Resource Guide for Small Adult Care
Facilities; B.C. Ministry of Health and Ministry Responsible for Seniors Ju=
ne
1999
=
&nb=
sp; =
Community
Care and Assisted Living Act Adult Care Regulations; 7-7.11
7.F Nutrition:
7.F: 1: Nutrition =
and Food
Services Audit Program
Managers are responsi=
ble for
ensuring compliance with the Nutrition and Food Services Audit Program. A f=
ood
and nutrition information sheet and a nutrition care plan summary with
concerns, goals, actions and person responsible are completed within fourte=
en
(14) days of a person moving into a home, is reviewed at 14 weeks, and as
needed thereafter. (p. 78-80 Meals and More). Resident Satisfaction Survey =
(p.
140 Meals and More) is completed annually. As a screening tool the form
“When to Obtain Services of Registered Dietitian Nutritionist” =
(p.
69 Meals and More) is completed annually or as needed based on the presenta=
tion
of the person supported. Nutrition Care Plan Checklist (p. 142 Meals and Mo=
re)
helps to keep the nutrition care plan up to date and is completed annually.
These documents are kept in the nutrition section of the person’s bin=
der
for easy reference.
All Managers keep a N=
utrition
Audit File with a menu checklist (p. 139 Meals and More). This checklist is
completed whenever there are changes to the menu. Licensing nutritionist
recommends a four-week menu cycle. Because of changes in 2007 to the Canada
Food Guide, the licensing nutritionist is revising menu checklist and it wi=
ll
be circulated when available. Managers are responsible for ensuring
substitution records are kept for changes to the menu plan (p. 19 Meals and
More).
For Managers/PICs res=
ponsible
for food service, Meals and More Checklist (p. 143 Meals and More) is to be
completed and kept in the Nutrition Audit File. For people supported with an
HSCL professional providing input into the nutrition care plan, copies of
changes should be kept in the Nutrition Audit File.
Individual Care Plans=
which
are used to train new staff to the needs of the people in the home when a
nutrition health care plan from an HSCL professional does not exist, outlin=
es
assistance/special requirements during eating, nutritional concerns, food a=
nd
drink textures, the persons participation in food preparation, and any spec=
ial
considerations for getting monthly weights. ICPs are updated annually in
conjunction with PCPs.
Annually, Kardel comp=
letes an
information and binder audit in all homes and programs to ensure comprehens=
ive
documentation and follow through.
Policy: =
; &n=
bsp; Individual
Centered Services
Issued: =
; &n=
bsp; June
2007
Reviewed: &n=
bsp; Dec=
ember
2007; May 2009
References: = Meals and More: Quality Improvement and Resource Guide for Small Adult Care Facilities; B.C. Ministry of Health and Ministry Responsible for Seniors Ju= ne 1999 Community Care and Assisted Living Act Adult Care Regulations; 7-7.11<= o:p>
=
&nb=
sp; =
7.G. Health Ser=
vices
for Community Living (HSCL); Delegation/Transfer of Function
7.G. 1: Overview:
The people we support=
may
require the professional services of a Nurse, Occupational Therapist,
Physiotherapist, Dental Hygienist, a Registered Dietician, a Speech Language
Pathologist or Dysphagia Specialist. A request for these services should be
made through Greater Victoria Hospital Society, Health Services for Communi=
ty
Living (HSCL) Branch.
HSCL reviews the requ=
est and
determines if they will provide the person with HSCL professional services =
and
back up support or if an alternate plan will meet the needs. Not all the pe=
ople
we support with medical issues require service. Standard practices for care=
may
have been previously developed and Individual Care Plans (ICP) are already =
in
place for the long term. HSCL bases their decision on the current situation=
and
need, as well as judgment about the severity of the situation.
When HSCL accepts a p=
erson
for service, they work with the manager and team to develop a Health Care P=
lan
(HCP). The Health Care Plan is an HSCL document and any changes/alterations=
to
the document must be signed by HSCL. The exception is that a Kardel Nurse
Manager’s role is interchangeable with a HSCL Nurse.
People that are not s=
upported
by HSCL may have similar health care and/or personal care issues that would=
be
addressed in an Individual Care Plan (ICP) that is produced by a Kardel Man=
ager
and staff members with input from health professionals, other than HSCL, as=
required.
Kardel’s nurse consultant is available as a resource.
7.G. 2: Consent to health care and rehabilitation
treatment:
All health care pract=
itioners
are required to have the consent of the person being treated prior to provi=
sion
of health care. When the health care professional, based on their assessmen=
t of
the situation, determines that the person is not able to give consent, the
health care practitioner is required to get substitute consent from the
committee, representative, or temporary substitute decision maker prior to
proceeding with the provision of health care.
It is Kardel’s
responsibility to remain current on the appropriate person to provide conse=
nt
and provide this information to the health care provider.
7.G. 3: Levels of Care:
HSCL has organized He=
alth
Procedures into three sections according to the level of skill, which is
required to perform them. A comprehensive listing of Levels of Care is avai=
lable
through the Kardel nurse consultant.
It is the responsibil=
ity of
Kardel managers to inform the HSCL team of the care needs of the person,
provide details of the care environment (home, equipment etc.), and relevant
information pertaining to the training and skills of staff members to assist
HSCL in their decision making re: the transfer of tasks.
Section I A: One care=
giver
may teach another caregiver. HSCL may include general recommendations.
Examples: bathing, dr=
essing,
grooming, nail care, oral hygiene skin care, toileting, rehabilitation
(positioning, equipment and adaptive aids), and bowel care.
Section I B: HSCL may=
, at
their discretion, initially teach the manager and care staff so that they m=
ay
teach other staff members in the future.
Examples: use of pres=
cribe
adrenaline kit for allergic reaction, bowel care (routine suppositories), l=
ifts
and transfers, meal management for dysphagia, medication administration, os=
tomy
care, positioning, mobilization and activity, prosthetics and orthotics,
seizure management and urinary drainage.
Section II tasks requ=
ire the
expertise and clinical judgment of a health care professional to train the
staff members directly and sign off as fixed point of responsibility that t=
he
staff members have the competence to complete the Section II task. The trai=
ning
is always person specific and not generic. The health care professional has=
the
responsibility for producing the written health care plan and the staff mem=
bers
perform the duties consistent with this plan. (Once the HCP is sure that the
procedure is routine, and no longer requires HCP training, the HCP may appr=
ove
the transfer of the task to the Individual Care Plans (ICP), which removes =
the
requirement for ongoing HSCL involvement with the training of the task.)
The Kardel R.N. Manag=
er,
Kardel Nurse Consultant, or R.P.N. Manager’s role is interchangeable =
with
the HSCL nursing role. The R.N./RPN completes the Section 2 training when
required for staff and signs off staff members. H.S.C.L. nurse functions in=
the
role of back up support. A Health Care Plan is written by the R.N/R.P.N in
conjunction with the health care team. HSCL dysphagia, nutrition and physio
team members are responsible for their own pages of the care plan. The HSCL
nurse formats the plan into the HSCL format and forwards to HSCL and Group
Home. HSCL nurse reviews the plan, completes the Delegation/Transfer of
Function Letter of Agreement with Primary/Community Care & Community He=
alth
Centres and forwards it to the Kardel R.N., R.P.N who signs off on behalf of
the company.
Nursing Examples: bow=
el care
(manual disimpaction, prepared disposable enema), bladder care, dressings,
gastrostomy care, blood glucose testing, ostomy care;
PRN medications when =
judgment
by staff members is required.
Rehabilitation Exampl=
es:
Therapeutic movement routines and activation, application of a Transcutaneo=
us
Nerve Stimulation Machine (TNS), neuromuscular stimulator (NMES) or high
voltage galvanic stimulator (HVGS), use of prosthetics and orthotics, cold
packs, oral and nasal suctioning,
Nutrition and/or
Rehabilitation: gastrostomy care, oral motor stimulation
Section III tasks req= uire the expertise and clinical judgment of a health care professional and are not normally delegated. Exceptions may occur when the person’s status in a home is stable. HSCL staff members must consult with the Kardel manager, the Community Services Coordinator responsible for HSCL, and with the disciplin= e-specific professional associations/colleges prior to the transfer of a Section III.<= o:p>
Otherwise, Kardel sta=
ff would
call upon HSCL to perform these tasks. Examples: Tracheal suctioning,
tracheostomy care, ventilator care, nasogastric and gastrostomy tube insert=
ion,
insertion of an indwelling catheter, bladder irrigation, application of com=
plex
dressings, administration of IM injections, initiate and monitor present
medication pumps, electrotherapy modalities, joint manipulation, vertebral
joint mobilizations, selection of fluids/feeds, feeding pump, and the rate =
of
infusion, change of food/liquid and textures/consistencies; equipment
prescription.
7.G. 7: Acceptance of Delegation/Transfer of Fun=
ction:
The HSCL Health Care
Professional completes a “Delegation/Transfer of Function: Letter of
Agreement with Primary/Communication Care” with tasks listed and
Kardel’s representative, the managers, sign the agreement to accept t=
he
Section II Transfer of Function Tasks as outlined in the Letter. These lett=
ers
should be kept in Section II file on site. This letter should be signed pri=
or
to the caregiver training date. HSCL is responsible for sending a copy of t=
he
Letter of Agreement to the analyst.
On the training day, =
the
“Letter of Agreement with Primary/Community Care” indicates when
Health Care Professional will be contacted; Kardel’s manager and the
names of the trained staff members; and details of the delegation.
The manager’s d=
ecision
to accept Transfer of Function is based on their knowledge and confidence t=
hat
the resources are available within the home to accept the responsibility for
completing the task. Responsibility is shared between the Health Care
Professional who delegates the task, Kardel who accepts the delegated task,=
and
the staff member who carries out the task.
A physician, with a
person’s changing health care needs, may make recommendations for cha=
nges
to the provision of health care that vary from the methods recommended by H=
SCL.
The manager should request the physician provide written direction. A copy =
of
this should be faxed as soon as possible to the HSCL professional for their
amendment of their directions in the Health Care Plan. Potentially, they co=
uld
initial the Doctor’s directions and Fax back until such time as the H=
CP
can be updated. The manager should arrange for new training if it is necess=
ary.
A delay in response from HSCL should not subject the person supported to
incorrect or insufficient care. The manager should ensure clear directions =
are
available to staff members to avoid confusion and protect the person, the s=
taff
members and the agency.
Staff members are res=
ponsible
for ensuring their readiness to carry out a delegated task as directed, and
following the written procedure.
HSCL completes the “Record of Current Trained Caregivers”
and a copy is kept in the Section II file in the homes. If a staff person h=
as
concerns about the process for completing the delegated tasks and would lik=
e to
advocate for a change, they may bring their concern in writing to the manag=
er. The
manager would review the concern and may request a review by the HSCL
professional. If concern remains, the manager may request a second opinion =
from
HSCL. Kardel would be in contravention of its agreement with HSCL if the
procedures were not carried out in the manner in which the HSCL staff membe=
rs
trained Kardel’s care staff.
7.G. 8: HSCL Staff Training for a Delegated Func=
tion:
The HSCL Health Care =
Provider
teaches performance of the task, writes up the description in the Heath Care
Plan, and observes the staff members competently demonstrating the skill.
7.G. 9: HSCL Monitoring of a Delegated Function<=
/span>:
The Health Care Profe=
ssional
will continue to monitor the care every 3-6 months or as necessary. This is
stipulated in the Letter of Agreement done on the Caregiver Training Day.
7.G. 10: Staff members cross-registered without =
the
necessary Section II training:
Staff members that ha=
ve not
participated in Section II training in a home in which they are registered =
may
not work alone with the person but may work with another staff member that =
has
the necessary training. Scheduling should never result in a situation where=
no
staff member is on duty without Section II training. If in an emergency no
staff member is available with the necessary training, HSCL should be conta=
cted
to perform the procedure.
Policy: =
; &n=
bsp; Individual
Centered Services
Issued: &nbs=
p; &=
nbsp; December
2003
Reviewed: &n=
bsp; Nov=
ember
2007; May 2009
Reference: &=
nbsp; Transfer
of Function Guidelines
=
&nb=
sp; =
Bill
51 Health Care Consent
Ministry of Health Guidelines: Section 11: Health Services for Commu=
nity
Living: Transfer of Function Guidelines
=
<=
b>
7.H. 1: Overview: All documentation must be respectful of persons supported, other
staff members and professionals or other support people. It is essential th=
at
staff members document clearly, concisely and in a manner that conveys a
positive, collaborative and professional tone.
All documents are leg=
al
documents and can be summoned in a court of law.
7.H. 2: People Accessing their Records
All people supported =
have
access to their records by requesting access from the Manager in the
homes/program, or the staff member involved in the Individual Support Netwo=
rk.
Reports completed by another service/organization within the records of the
person supported may not be divulged and must be removed from the records p=
rior
to the review. Access should be provided within one week of the request.
Manager and/or staff members familiar with the needs of the person, will re=
main
with the person to review the records and ensure the information is present=
ed
to them in a manner that they understand and to provide emotional support w=
here
required. Reports that are part of an ongoing law enforcement investigation=
may
not be released. With the permission of the person supported, families and/=
or
caregivers may also have access to the individual’s records by reques=
t to
the Manager.
7.H. 3: Ownership of Records
All reports and docum=
entation
prepared by staff members in the course of their employment remain under the
protection of Kardel and may not be used except by express permission of the
owner/operator (or designate) for any purpose other than that which they we=
re
originally prepared. Hence, they may not be used for training, research, or
publication. Ownership of the records rests with CLBC.
7.H. 4: Security, Contents, Transfer and Storage=
The records of people
supported should be kept in a safe, secure place and not in public view. Th=
ey
should not be left unattended in unsecured areas. The office or the file
cabinet containing confidential information should be locked when unattende=
d by
staff members.
For transfer to hospi=
tal, the
hospital transfer form and most recent medication administration record sho=
uld
accompany the person rather than the complete binder.
The records of deceas=
ed
individuals will be kept in a secure and locked area at Central office; or
managed in the manner outlined for off-site storage and transfer of contrac=
tor
records as outlined by CLBC. Refer to the Records Retention Procedures, whi=
ch
outlines the documents that are retained, and documents that may be shredde=
d.
Personal information =
that
contains a supported person’s name or identifying information should =
not
be transmitted via E-Mail or Fax. (Reference technology plan for further
details)
Policy: =
; &n=
bsp; Orientation &=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; Confiden=
tiality
Issued: =
; &n=
bsp; 1999
Revised: &=
nbsp; October
2000; April 2001; January 2004; May 2009
Reviewed: &n=
bsp; Nov=
ember
2007;
References: &=
nbsp; Freedom
of Information and Protection of Privacy Act
=
&nb=
sp; =
Community
Care Facility Act: Adult Care Regulations 9.4
=
&nb=
sp; Off-site
storage and transfer of contractor records: MCF: Administrative Services
=
&nb=
sp; =
Clients
with Criminal Records: Policy 2806
=
&nb=
sp; =
A
Guide to the Privacy Charter
7.H. 5: Progress Notes/Charts:
Many of the people se=
rved are
not able to manage their own health issues. Hence, clear communication for
adequate daily monitoring is essential. Generally, the following informatio=
n is
recorded in progress notes or charted on specific forms :
Changes
in health status; medications changes or observations; seizure activity;
menstrual cycle; appetite changes; behaviour changes; emotional changes;
routines, activities and recreation; sleep patterns.
Bowel movements if the person is not independent for bowel care are
recorded on a Bowel Chart
=
Weight is monitored monthly on a weight chart.
All entries in progre=
ss notes
begin with the date and end with a full signature (First initial and full l=
ast
name is sufficient). Nurses include R.N. or R.P.N.
Charting is done in black or blue
ink. Administration of PRN
medications are noted in red ink.
Metric date (YY/MM/DD) and time (13=
00
hours) is used.
Staff members are req=
uired to
read each person’s progress notes at the beginning of each shift. They
should read back to when they last worked in the home.
Staff members are req=
uired to
record in the person’s progress notes at the end of each shift in leg=
ible
handwriting.
Example of appropriate
recording:
=
99.04.10:
1900 hours. Jane had a small amount of dinner tonight: half a potato, and o=
ne
meatball. She had no complaints this shift. --------------Signature
Destruction of a
person’s records is prohibited.
7.H. 6: Staff
Communication Book
All entries must be
respectful of persons supported, other staff members, professionals and oth=
er
support people. Staff members=
must
document in a manner that is positive, collaborative and professional in to=
ne.
The communication book is not to be used as a means to criticize others.
Staff members are exp=
ected to
read communication book at the beginning of each shift.
The communication book addresses ge=
neral
home/program information. This may include, but is not limited to, the
following:
Blanks should not be left in the progress notes or communication book. If a shift entry is missed, it must be written in as a “late entry”. Written communication book pages/ entries are the property of Kardel , are legal documents and may be summoned in a court of = law.
7.H. 7: Order of F=
iles for
People Supported
Files
have a consistent format throughout the homes:
Sections:
1: Profile and transfer checklist: includes application, consent forms, file
audit, essential phone numbers
Section
2: Individual Care Plans
Section
3: Health Care Plans
Section
4: Person Centred Plans: included semi-annual report
Section
5: Dr.s orders and notes; Medication order review; Health Care Summary and
related incident reports
Section
6: Lab and Diagnostic reports; immunization Records
Section
7: OT/Physio Consultations; Dental; Relevant History Reports
Section
8: Nutritional Information; consults; weight records
Section
9: Bowel/Menses record; seizure record
Section
10: Progress Notes: Flow Charts; Goal Tracking
Section 7: Individual Centred Service Pl=
anning